System, method, apparatus, device and computer program product for automatically detecting positioning effect

ABSTRACT

An automated system, method, apparatus, device and/or computer program product for detecting positioning effect is set forth, the apparatus according to an exemplary embodiment may include an output operable to couple to one or more stimulating electrodes to stimulate one or more peripheral nerves of the patient, an input operable to couple to one or more recording electrodes to record resultant electrical waveforms generated by a nervous system of a patient in response to the stimulating module, and one or more processors operable to identify the positioning effect based on the resultant electrical waveforms.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a divisional of U.S. patent application Ser. No.12/620,384, filed Nov. 17, 2009, which claims benefit to U.S.Provisional Application No. 61/185,441 filed Jun. 9, 2009, the entirecontents of which are hereby incorporated by reference.

FIELD OF THE INVENTION

The present invention relates to a medical device, and more particularlyto a device for injury detection.

BACKGROUND

During many types of surgeries, patients are positioned, e.g., bymedical workers, to facilitate surgical access in ways that may putundue tension or pressure on peripheral nervous structures. This unduetension or pressure can create what is generally termed as a“positioning effect.” Warning signs of positioning effect may includesensations, such as, e.g., but not limited to, numbness, tingling orweakness. During surgery, a patient is usually placed under generalanesthesia. Therefore, they would be unable to identify the usualwarning signs resulting from positioning effect. Consequentially, thepatient would be left in this compromised position for the duration ofthe surgical procedure. Continued trauma from positioning effect mayresult in prolonged or even permanent injury. An injury caused bypositioning effect is known as a “positioning effect injury.” What isneeded is a method to prevent positioning effect injuries.

SUMMARY OF THE INVENTION

In an exemplary embodiment of the present invention a system, method,device, apparatus, and/or computer program product for automaticallydetecting positioning effect and avoiding such injuries is disclosed.

According to an exemplary embodiment, a method of identifyingpositioning effect in a patient may be provided. According to anexemplary embodiment, the method may include stimulating one or moreperipheral nerves with one or more electrical pulses from one or morestimulating electrodes, recording resultant electrical waveformsgenerated by a nervous system of the patient in response to theelectrical pulses using one or more recording electrodes, andidentifying, by or with one or more computing devices, the positioningeffect based on the resultant electrical waveforms.

According to an exemplary embodiment, the one or more stimulatingelectrodes may be coupled to one or more of an arm of the patient, a legof the patient, an ulnar nerve of the patient, a median nerve of thepatient, or a posterior tibial nerve of the patient.

According to an exemplary embodiment, the one or more recordingelectrodes may be coupled to one or more of a trunk of the patient, anErb's point of the patient, a head of the patient or a neck of thepatient.

According to an exemplary embodiment, the resultant electrical waveformsmay be somatosensory evoked potential waveforms.

According to an exemplary embodiment, The identifying may include one ormore of comparing, with the computing device, information based on theresultant electrical waveforms to information from an anesthesia machineto determine when changes in the resultant electrical waveforms are dueto anesthesia and/or comparing, with the one or more computing devices,information based on the resultant electrical waveforms to informationfrom, e.g., but not limited to, a blood pressure machine to determinewhen changes in the resultant electrical waveforms are due to bloodpressure.

According to an exemplary embodiment, the method may further includedetermining how to reduce the positioning effect based on a position ofa table.

According to an exemplary embodiment, the method may further includeproviding information based on the positioning effect to a table.

According to an exemplary embodiment, the method may further includeproviding information to a table to at least partially reposition thetable to reduce the positioning effect.

According to an exemplary embodiment, the method may further includeadjusting a position of the patient based on the positioning effectusing an electro-mechanism of a table.

According to an exemplary embodiment, the method may further includealerting a user to the positioning effect using one or more of anotification, an alert, a communication, an indication, and/or an alarm.

The method may further include displaying information based on theresultant electrical waveforms on a display unit.

According to an exemplary embodiment, the method may further includereceiving a user input regarding the accuracy of the resultantelectrical waveforms.

According to an exemplary embodiment, an automated apparatus fordetecting positioning effect leading to a potential positioning effectinjury may include an output operable to connect and/or couple to one ormore stimulating electrodes to stimulate one or more peripheral nervesof a patient, an input operable to connect and/or couple to one or morerecording electrodes to record resultant electrical waveforms generatedby a nervous system in response to the one or more stimulatingelectrodes, and one or more processors, connected and/or coupled to theoutput and the input, operable to identify the positioning effect basedon the resultant electrical waveforms.

According to an exemplary embodiment, the processor may further includemeans for identifying the positioning effect which may include one ormore means for identifying changes in a latency of the resultantelectrical waveforms, means for identifying changes in an amplitude ofthe resultant electrical waveforms, and/or means for identifying changesin a morphology of the resultant electrical waveforms.

According to an exemplary embodiment, the apparatus may further includea display unit, connected and/or coupled to the one or more processors,operable to display information regarding the resultant electricalwaveforms.

According to an exemplary embodiment, the apparatus may further includean alert unit, coupled to the one or more processors, operable to alerta user to the positioning effect.

According to an exemplary embodiment, the apparatus may further includean interface, connected and/or coupled to the processor, operable tocouple a table to the processor.

According to an exemplary embodiment, the interface may be operable totransfer information between the table and the one or more processors toreduce the positioning effect.

According to an exemplary embodiment, the apparatus may further includea table.

According to another exemplary embodiment, the apparatus may furtherinclude one or more means for obtaining information from an anesthesiamachine to determine when changes in the resultant electrical waveformsare due to anesthesia; an anesthesia machine; means for obtaininginformation from a blood pressure machine to determine when changes inthe resultant electrical waveforms are due to blood pressure; or a bloodpressure machine.

Further features and advantages of the invention, as well as thestructure and operation of various exemplary embodiments of theinvention, are described in detail below with reference to theaccompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other features and advantages of the invention will beapparent from the following, more particular description of a preferredembodiment of the invention, as illustrated in the accompanying drawingswherein like reference numbers generally indicate identical,functionally similar, and/or structurally similar elements. The leftmost digits in the corresponding reference number indicate the drawingin which an element first appears.

FIG. 1 depicts an exemplary diagram of the system according to anexemplary embodiment of the present invention;

FIG. 2 depicts an exemplary embodiment of a computer system that may beused in association with, in connection with, and/or in place of, butnot limited to, any of the foregoing components and/or systems; and

FIG. 3 depicts an exemplary diagram of the table, according to anexemplary embodiment of the present invention.

DETAILED DESCRIPTION OF AN EXEMPLARY EMBODIMENT OF THE PRESENT INVENTION

Various exemplary embodiments of the invention including preferredembodiments are discussed in detail below. While specific exemplaryembodiments are discussed, it should be understood that this is done forillustration purposes only. A person skilled in the relevant art willrecognize that other components and configurations can be used withoutparting from the spirit and scope of the invention.

The danger of positioning effect injuries is recognized. Despite carefulpositioning and padding of structures at risk to positioning effect byoperating room teams, positioning effect injuries still occur insignificant numbers in many surgical types. See, for example, C. J.Winfree and D. G. Kline, “Intraoperative positioning nerve injuries,”Surgical Neurology, 63(1), pages 5-18, published 2005. Surgical tableequipment manufacturers spend considerable time and energy engineeringsurgical tables attempting to prevent such injuries.

Impending positioning effect injuries can be detected based onsomatosensory evoked potentials (SEPs) by specially trained personnelusing conventional attended intraoperative neurophysiologic monitoring(IONM) systems. SEPs are summated electrical potentials usually recordedfrom the head or neck area after repeatedly stimulating a peripheralnerve. Monitoring patients using SEPs during surgery has been shown toallow early identification of impending positioning effect injury thatcan then be avoided by repositioning the patient to alleviate pressureor tension causing the positioning effect. See Hickey, C.; Gugino, L.D.; Aglio, L. S.; Mark, J. B.; Son, S. L. & Maddi, R., “Intraoperativesomatosensory evoked potential monitoring predicts peripheral nerveinjury during cardiac surgery,” Anesthesiology, 78(1), pages 29-35,published 1992; Kamel, I. R.; Drum, E. T.; Koch, S. A.; Whitten, J. A.;Gaughan, J. P.; Barnette, R. E. & Wendling, W. W., “The use ofsomatosensory evoked potentials to determine the relationship betweenpatient positioning and impending upper extremity nerve injury duringspine surgery: a retrospective analysis,” Anesthesia & Analgesia,102(5), pages 1538-1542, published 2006; and Labrom, R. D.; Hoskins, M.;Reilly, C. W.; Tredwell, S. J. & Wong, P. K. H., “Clinical usefulness ofsomatosensory evoked potentials for detection of brachial plexopathysecondary to malpositioning in scoliosis surgery,” Spine, 30(18), pages2089-2093, published 2005.

However the IONM procedure is not automated, not available everywhere,is expensive, and is not traditionally performed for many types ofsurgery that give rise to positioning effect. In addition, IONM is notpractical for use anywhere outside the operating room whereunresponsive, weak or confined patients may incur positioning effect.Such monitoring may generally require highly trained technologists underphysician supervision with sophisticated multichannel amplifier anddisplay equipment. Unfortunately, such personnel and equipment arelimited in availability, require pre-booking, and are costly. Inaddition, such monitoring is not traditionally done in many of thesurgeries in which positioning effect occurs and is not traditionallydone outside of the operating room where patients may remain at risk.

An algorithm for neurophysiology monitoring capable of quickly findingstimulation thresholds over multiple channels of a neurophysiologymonitoring system is described in U.S. Patent Application No.20080167574, to Farquhar, entitled “Multi-Channel Stimulation ThresholdDetection Algorithm For Use In Neurophysiology Monitoring,” filed Sep.22, 2006, published Jul. 10, 2008, the contents of which areincorporated herein by reference in their entirety. However, thepublication focuses on the use of an algorithm to determine stimulationthresholds for evoking neuromuscular responses and does not addresspositioning effect.

In an exemplary embodiment, a system, method, device and/or computerprogram product for automatically detecting positioning effect may beused to, e.g., but not limited to, detect, alert and/or ameliorate,etc., positioning effect during any surgery or situation where a patientis at risk, such as, e.g., but not limited to, an unconscious patient, aconfined patient, an enfeebled patient, an anesthetized patient, etc.

FIG. 1 depicts an exemplary diagram of a system according to anexemplary embodiment of the present invention. According to an exemplaryembodiment, the system 100, which may be coupled to a patient 101, mayinclude, e.g., but not limited to, one or more recording electrodes 102,one or more stimulating electrodes 103, a positioning effect detectiondevice (PEDD) 104, a table integration unit 105, an alert and display(or other output) unit 106, and a table 107. In an exemplary embodiment,the table 107 may include, e.g., but not limited to, any surface uponwhich the patient 101 may be placed, a bed, a chair, an operating roomtable, a pre-op table, and/or a post-op table, etc.

According to an exemplary embodiment, the recording electrodes 102 maybe coupled to the head, neck, arms, legs, trunk, Erb's point and/ortorso of the patient 101, and stimulating electrodes 103 may be coupledto the arms and/or legs of the patient 101.

According to an exemplary embodiment, the PEDD 104 may be electronicallycoupled to recording electrodes 102 and stimulating electrodes 103. Inan exemplary embodiment, the PEDD 104 may be part of, may be coupled to,and/or may include, a computer. According to an exemplary embodiment,the PEDD 104 may include a computer, such as, e.g., but not limited to,the computer set forth in and described further below with reference toFIG. 2. In an exemplary embodiment, PEDD 104 may be electrically,electronically, and/or mechanically coupled to the table integrationunit 105 and/or the alert and display unit 106.

According to an exemplary embodiment, the table integration unit 105 maybe mechanically and/or electronically coupled to the table 107 and/orPEDD 104. In an exemplary embodiment, the table integration unit 105 maybe incorporated in the table 107 and/or PEDD 104.

According to an exemplary embodiment, the alert and display unit 106 maybe any of various well known output devices. In an exemplary embodiment,the alert and display unit 106 may be mechanically and/or electricallycoupled to the PEDD 104 and/or table 107. According to an exemplaryembodiment, the alert and display unit 106 may be incorporated in thetable 107 and/or PEDD 104.

In an exemplary embodiment, the PEDD 104 may detect positioning effectin a patient 101 lying on the table 107 using the stimulating electrodes103 and the recording electrodes 102. According to an exemplaryembodiment, the PEDD 104 may communicate positioning effect informationusing the alert and display unit 106 to, e.g., operating room personnel.

In one exemplary embodiment, the PEDD 104 may further, correctpositioning effect using a table integration unit 105 providing formovement of the table 107 to correct positioning effect.

According to an exemplary embodiment, the PEDD 104 may stimulate sensoryor mixed nerves of the patient using the stimulating electrodes 103 toproduce SEPs. In an exemplary embodiment, a PEDD 104 may be attached,coupled and/or connected to the patient 101 with stimulating electrodes103, e.g., near the arms or legs over peripheral nervous structures,such as, but not limited to, e.g., the ulnar nerves, median nerves andposterior tibial nerves.

According to an exemplary embodiment, the PEDD 104 may use the recordingelectrodes 102 to detect SEPs generated by a patient's nervous system inresponse to the stimulation from the stimulating electrodes 103. In anexemplary embodiment, recording electrodes 102 may be attached,connected, and/or coupled over the spine, neck, and/or head.

According to an exemplary embodiment, based on the observed SEPs, thePEDD 104 may identify potential positioning effect injuries caused bypositioning of the patient 101. In an exemplary embodiment, the PEDD 104may detect changes in the SEPs, such as, e.g., but not limited to,changes in latency, changes in amplitude or changes in morphology.According to an exemplary embodiment, changes, such as, e.g., but notlimited to, reductions or aberrations in the SEPs may indicate apositioning effect. In an exemplary embodiment, the PEDD 104 mayidentify a particular nerve structure affected by positioning effectbased on the SEPs. The PEDD 104 may further recommend actions toameliorate the positioning effect by recommending changes in position.In one exemplary embodiment, the PEDD 104 may move the patientautomatically so as to prevent positioning effect injury to the patient101.

In an exemplary embodiment, the stimulating electrode 103 may beincorporated into the PEDD 104, coupled to the PEDD 104, or attachableor connectable, directly or indirectly to the PEDD 104. According to anexemplary embodiment, the PEDD 104 may sequentially stimulate peripheralnerves via the stimulating electrode 103 while recording the SEPs viathe recording electrode 102. According to an exemplary embodiment, thePEDD 104 may include an output operable to couple to the stimulatingelectrodes 103. In an exemplary embodiment, the recording electrodes 102may be at least one of, incorporated into the PEDD 104, coupled to thePEDD 104, or attachable or connectable, directly or indirectly to thePEDD 104. According to an exemplary embodiment, the PEDD 104 may includean input operable to couple the PEDD 104 to the recording electrode 102.In an exemplary embodiment, the PEDD 104 may include a processor, amemory, a storage device or a computer.

In an exemplary embodiment, the SEPs may be returned to the PEDD 104 aselectrical signals recorded by the recording electrodes 102. In anexemplary embodiment, the PEDD 104 may include standard industrycomponents, such as, e.g., but not limited to, electric stimulators,pre-amplifiers, amplifiers and/or computer components, etc., to controlstimulation and process return signals. According to an exemplaryembodiment, the response to several stimuli may be averaged together toreduce noise and produce a clean signal. In an exemplary embodiment,proprietary or third party software may be used in signal processing toimprove the signal-to-noise ratio and reduce the number of stimulirequired to obtain a clean signal.

According to an exemplary embodiment, proprietary software may also beused to compare signals between limbs of a patient 101 to eliminatealerts from changes in signals due to systemic effects of anesthesia orblood pressure changes. In an exemplary embodiment, the PEDD 104 mayobtain anesthesia information from an anesthesia machine and maycalculate if changes in signals are due to anesthesia. According to anexemplary embodiment, the PEDD 104 may obtain blood pressure informationfrom a blood pressure machine and may calculate if changes in signalsare due to changes in a patient's sensed blood pressure.

In an exemplary embodiment, the alert and display unit 106 may include adisplay which may display various information, such as, e.g., but notlimited to, areas being stimulated and recorded from, baseline andcurrent signal traces, trends in signals, relevant changes in signals,location of signal changes, quality of recorded signals, position ofelectrodes, position of the table 107 or other similar device, locationof table parts associated with body position, alerts due to significantchanges in signals, and proposed or impending movements in the table 107or similar device to mitigate the monitoring signal changes. Inaddition, the alert and display unit 106 may include, e.g., but notlimited to, multiple buttons or control inputs. According to anexemplary embodiment, the buttons or inputs may allow an operator to setup the initial monitoring layout and interact with the alert and displayunit 106 during monitoring to add additional information or respond toalerts. In an exemplary embodiment, the alert and display unit 106 mayallow override of a change in signal by, e.g., but not limited to, ananesthesiologist, or other medical personnel, etc., when a signal changeis related to a change in dose of anesthetic agent or some other eventunrelated to positioning effect.

According to an exemplary embodiment, the PEDD 104 may include aninterface operable to transfer information between the table integrationunit 105 and the table 107. In an exemplary embodiment, the tableintegration unit 105 may pass information to and from the table 107regarding the signals and positions of parts of the table. In anexemplary embodiment, the table integration module 105 may send signalsto the table 107 instructing the table 107 to move in response tochanges in SEPs in order to mitigate positioning effect.

According to an exemplary embodiment, the table integration unit 105 mayobtain information from the table 107 about the position of the table'svarious parts, and any of the table's parts associated with the positionof the patient's limbs. In an exemplary embodiment, the tableintegration unit 105 may update information in real time. In anexemplary embodiment, the PEDD 104 may receive the table positioninformation and determine how to alleviate positioning effect based onthe table position information. According to an exemplary embodiment,the table integration unit 105 may transfer information regarding apotential positioning effect injury and may cause the table 107 tochange in position to alleviate the potential injury.

In an exemplary embodiment, the table integration module 105 may sendsignals to the table 107 instructing the table 107 to move in responseto changes in signals in order to mitigate positioning effect. Accordingto an exemplary embodiment, the table 107 may move based on instructionsfrom a table integration module 105. In an exemplary embodiment, thetable 107 may include servo-mechanism controlled parts, and/or otherelectro-mechanical moving parts, and may position parts of the table 107using the electro-mechanisms. According to an exemplary embodiment, thePEDD 104 may be integrated into a table 107. In an exemplary embodiment,the table integration unit 105 may be left out when using tables 107that do not have sufficient moving parts or automated moving parts.

According to an exemplary embodiment, the PEDD 104 and table 107 maycooperatively move the patient 101 so as to prevent positioning effectinjuries. In an exemplary embodiment, the PEDD 104 may identify apotential positioning effect injury. According to an exemplaryembodiment, the table 107 may then move the patient 101 so as to avoidpotential injury. In an exemplary embodiment, the PEDD 104 may thendetermine if the positioning effect has been reduced. According to anexemplary embodiment, if the positioning effect has been reduced, thetable 107 may reposition the patient further so that the positioningeffect is eliminated. In an exemplary embodiment, if the positioningeffect has not been reduced, the table 107 may reposition the patientdifferently. According to an exemplary embodiment, if the positioningeffect is worsened, the table 107 may reposition the patient back to thepatient's original position. In an exemplary embodiment, the table 107may include, e.g., but is not limited to, any surface upon which thepatient 101 may be placed, a bed, a chair, an operating room table, apre-operation table, and/or a post-operation table.

In an exemplary embodiment, the table integration unit 105 and/or thealert or the display unit 106 may be subcomponent modules of the PEDD104 or may be coupled to the PEDD 104. According to an exemplaryembodiment, an override functionality may be another subcomponent moduleof the PEDD 104. Override functionality may include interaction with thePEDD 104 at any time by several methods including tactile or voicecommand.

Exemplary Processing and Communications Embodiments

FIG. 2 depicts an exemplary embodiment of a computer system 200 that maybe used in association with, in connection with, and/or in place of,e.g., but not limited to, any of the foregoing components and/orsystems.

The present embodiments (or any part(s) or function(s) thereof) may beimplemented using hardware, software, firmware, or a combination thereofand may be implemented in one or more computer systems or otherprocessing systems. In fact, in one exemplary embodiment, the inventionmay be directed toward one or more computer systems capable of carryingout the functionality described herein. An example of a computer system200 is shown in FIG. 2, depicting an exemplary embodiment of a blockdiagram of an exemplary computer system useful for implementing thepresent invention. Specifically, FIG. 2 illustrates an example computer200, which in an exemplary embodiment may be, e.g., (but not limited to)a personal computer (PC) system running an operating system such as,e.g., (but not limited to) WINDOWS MOBILE™ for POCKET PC, or MICROSOFT®WINDOWS® NT/98/2000/XP/CE/7/VISTA, etc. available from MICROSOFT®Corporation of Redmond, Wash., U.S.A., SOLARIS® from SUN® Microsystemsof Santa Clara, Calif., U.S.A., OS/2 from IBM® Corporation of Armonk,N.Y., U.S.A., Mac/OS from APPLE® Corporation of Cupertino, Calif.,U.S.A., etc., or any of various versions of UNIX® (a trademark of theOpen Group of San Francisco, Calif., USA) including, e.g., LINUX®,HPUX®, IBM AIX®, and SCO/UNIX®, etc. However, the invention may not belimited to these platforms. Instead, the invention may be implemented onany appropriate computer system running any appropriate operatingsystem. In one exemplary embodiment, the present invention may beimplemented on a computer system operating as discussed herein. Anexemplary computer system, computer 200 is shown in FIG. 2. Othercomponents of the invention, such as, e.g., (but not limited to) acomputing device, a communications device, a telephone, a personaldigital assistant (PDA), a personal computer (PC), a handheld PC, clientworkstations, thin clients, thick clients, proxy servers, networkcommunication servers, remote access devices, client computers, servercomputers, routers, web servers, data, media, audio, video, telephony orstreaming technology servers, etc., may also be implemented using acomputer such as that shown in FIG. 2.

The computer system 200 may include one or more processors, such as,e.g., but not limited to, processor(s) 204. The processor(s) 204 may beconnected to a communication infrastructure 206 (e.g., but not limitedto, a communications bus, cross-over bar, or network, etc.). Variousexemplary software embodiments may be described in terms of thisexemplary computer system. After reading this description, it willbecome apparent to a person skilled in the relevant art(s) how toimplement the invention using other computer systems and/orarchitectures.

Computer system 200 may include a display interface 202 that mayforward, e.g., but not limited to, graphics, text, and other data, etc.,from the communication infrastructure 206 (or from a frame buffer, etc.,not shown) for display on the display unit 230.

The computer system 200 may also include, e.g., but may not be limitedto, a main memory 208, random access memory (RAM), and a secondarymemory 210, etc. The secondary memory 210 may include, for example, (butmay not be limited to) a hard disk drive 212 and/or a removable storagedrive 214, representing a floppy diskette drive, a magnetic tape drive,an optical disk drive, a magneto-optical disk drive, a compact diskdrive CD-ROM, a digital versatile disk (DVD), a write once read many(WORM) device, a flash memory device, etc. The removable storage drive214 may, e.g., but not limited to, read from and/or write to a removablestorage unit 218 in a well known manner. Removable storage unit 218,also called a program storage device or a computer program product, mayrepresent, e.g., but not limited to, a floppy disk, a magnetic tape, anoptical disk, a magneto-optical disk, a compact disk, a flash memorydevice, etc. which may be read from and written to by removable storagedrive 214. As will be appreciated, the removable storage unit 218 mayinclude a computer usable storage medium having stored therein computersoftware and/or data.

In alternative exemplary embodiments, secondary memory 210 may includeother similar devices for allowing computer programs or otherinstructions to be loaded into computer system 200. Such devices mayinclude, for example, a removable storage unit 222 and an interface 220.Examples of such may include a program cartridge and cartridge interface(such as, e.g., but not limited to, those found in video game devices),a removable memory chip (such as, e.g., but not limited to, an erasableprogrammable read only memory (EPROM), or programmable read only memory(PROM) and associated socket, and other removable storage units 222 andinterfaces 220, which may allow software and data to be transferred fromthe removable storage unit 222 to computer system 200.

Computer 200 may also include an input device 216 such as, e.g., (butnot limited to) a mouse or other pointing device such as a digitizer,and a keyboard or other data entry device (none of which are labeled).

Computer 200 may also include output devices 240, such as, e.g., (butnot limited to) display 230, and display interface 202. Computer 200 mayinclude input/output (I/O) devices such as, e.g., (but not limited to)communications interface 224, cable 228 and communications path 226,etc. These devices may include, e.g., but not limited to, a networkinterface card, and modems (neither are labeled). Communicationsinterface 224 may allow software and data to be transferred betweencomputer system 200 and external devices. Examples of communicationsinterface 224 may include, e.g., but may not be limited to, a modem, anetwork interface (such as, e.g., an Ethernet card), a communicationsport, a Personal Computer Memory Card International Association (PCMCIA)slot and card, etc. Software and data transferred via communicationsinterface 224 may be in the form of signals 228 which may be electronic,electromagnetic, optical or other signals capable of being received bycommunications interface 224. These signals 228 may be provided tocommunications interface 224 via, e.g., but not limited to, acommunications path 226 (e.g., but not limited to, a channel). Thischannel 226 may carry signals 228, which may include, e.g., but notlimited to, propagated signals, and may be implemented using, e.g., butnot limited to, wire or cable, fiber optics, a telephone line, acellular link, an radio frequency (RF) link and other communicationschannels, etc.

In this document, the terms “computer program medium” and “computerreadable medium” may be used to generally refer to media such as, e.g.,but not limited to removable storage drive 214, a hard disk installed inhard disk drive and/or other storage device 212, and signals 228, etc.These computer program products may provide software to computer system200. The invention may be directed to such computer program products.

An algorithm is here, and generally, considered to be a self-consistentsequence of acts or operations leading to a desired result. Theseinclude physical manipulations of physical quantities. Usually, thoughnot necessarily, these quantities take the form of electrical ormagnetic signals capable of being stored, transferred, combined,compared, and otherwise manipulated. It has proven convenient at times,principally for reasons of common usage, to refer to these signals asbits, values, elements, symbols, characters, terms, numbers or the like.It should be understood, however, that all of these and similar termsare to be associated with the appropriate physical quantities and aremerely convenient labels applied to these quantities.

Unless specifically stated otherwise, as apparent from the followingdiscussions, it is appreciated that throughout the specificationdiscussions utilizing terms such as “processing,” “computing,”“calculating,” “determining,” or the like, refer to the action and/orprocesses of a computer or computing system, or similar electroniccomputing device, that manipulate and/or transform data represented asphysical, such as electronic, quantities within the computing system'sregisters and/or memories into other data similarly represented asphysical quantities within the computing system's memories, registers orother such information storage, transmission or display devices.

In a similar manner, the term “processor” may refer to any device orportion of a device that processes electronic data from registers and/ormemory to transform that electronic data into other electronic data thatmay be stored in registers and/or memory. A “computing platform” maycomprise one or more processors.

Embodiments of the present invention may include apparatuses and/ordevices for performing the operations herein. An apparatus may bespecially constructed for the desired purposes, or it may comprise ageneral purpose device selectively activated or reconfigured by aprogram stored in the device.

Embodiments of the invention may be implemented in one or a combinationof hardware, firmware, and software. Embodiments of the invention mayalso be implemented as instructions stored on a machine-readable medium,which may be read and executed by a computing platform to perform theoperations described herein. A machine-readable medium may include anymechanism for storing or transmitting information in a form readable bya machine (e.g., a computer). For example, an exemplary machine-readablestorage medium may include, e.g., but not limited to, read only memory(ROM); random access memory (RAM); magnetic disk storage media; opticalstorage media; magneto-optical storage media; flash memory devices;other exemplary storage devices capable of storing electrical, optical,acoustical or other form of propagated signals (e.g., carrier waves,infrared signals, digital signals, etc.) thereon, and others.

Computer programs (also called computer control logic), may includeobject oriented computer programs, and may be stored in main memory 208and/or the secondary memory 210 and/or removable storage units 214, alsocalled computer program products. Such computer programs, when executed,may enable the computer system 200 to perform the features of thepresent invention as discussed herein. In particular, the computerprograms, when executed, may enable the processor or processors 204 toprovide a method to control and/or manage operation of a positioningeffect detection device according to an exemplary embodiment of thepresent invention. Accordingly, such computer programs may representcontrollers of the computer system 200.

In another exemplary embodiment, the invention may be directed to acomputer program product comprising a computer readable medium havingcontrol logic (computer software) stored therein. The control logic,when executed by the processor 204, may cause the processor 204 toperform the functions of the invention as described herein. In anotherexemplary embodiment where the invention may be implemented usingsoftware, the software may be stored in a computer program product andloaded into computer system 200 using, e.g., but not limited to,removable storage drive 214, hard drive 212 or communications interface224, etc. The control logic (software), when executed by the processor204, may cause the processor 204 to perform the functions of theinvention as described herein. The computer software may run as astandalone software application program running atop an operatingsystem, or may be integrated into the operating system.

In yet another embodiment, the invention may be implemented primarily inhardware using, for example, but not limited to, hardware componentssuch as application specific integrated circuits (ASICs), or one or morestate machines, etc. Implementation of the hardware state machine so asto perform the functions described herein will be apparent to personsskilled in the relevant art(s).

In another exemplary embodiment, the invention may be implementedprimarily in firmware.

In yet another exemplary embodiment, the invention may be implementedusing a combination of any of, e.g., but not limited to, hardware,firmware, and software, etc.

Exemplary embodiments of the invention may also be implemented asinstructions stored on a machine-readable or accessible storage medium,which may be read and executed by a computing platform to perform theoperations described herein. A machine-readable storage medium mayinclude any mechanism for storing or transmitting information in a formreadable by a machine (e.g., a computer). For example, amachine-readable medium may include, e.g., but not limited to, read onlymemory (ROM); random access memory (RAM); magnetic disk storage media;optical storage media; magneto-optical storage media; flash memorydevices; other exemplary storage devices capable of storing electrical,optical, acoustical or other form of propagated signals (e.g., carrierwaves, infrared signals, digital signals, etc.) thereon, and others.

The exemplary embodiment of the present invention makes reference to,e.g., but not limited to, communications links, wired, and/or wirelessnetworks. Wired networks may include any of a wide variety of well knownmeans for coupling voice and data communications devices together. Abrief discussion of various exemplary wireless network technologies thatmay be used to implement the embodiments of the present invention noware discussed. The examples are non-limiting. Exemplary wireless networktypes may include, e.g., but not limited to, code division multipleaccess (CDMA), spread spectrum wireless, orthogonal frequency divisionmultiplexing (OFDM), 1 G, 2 G, 3 G wireless, Bluetooth, Infrared DataAssociation (IrDA), shared wireless access protocol (SWAP), “wirelessfidelity” (Wi-Fi), WIMAX, and other IEEE standard 802.11-compliantwireless local area network (LAN), 802.16-compliant wide area network(WAN), and ultrawideband (UWB) networks, etc.

Bluetooth is an emerging wireless technology promising to unify severalwireless technologies for use in low power radio frequency (RF)networks.

IrDA is a standard method for devices to communicate using infraredlight pulses, as promulgated by the Infrared Data Association from whichthe standard gets its name. Since IrDA devices use infrared light, theymay depend on being in line of sight with each other.

The exemplary embodiments of the present invention may make reference toWLANs. Examples of a WLAN may include a shared wireless access protocol(SWAP) developed by Home radio frequency (HomeRF), and wireless fidelity(Wi-Fi), a derivative of IEEE 802.11, advocated by the wireless Ethernetcompatibility alliance (WECA). The IEEE 802.11 wireless LAN standardrefers to various technologies that adhere to one or more of variouswireless LAN standards. An IEEE 802.11 compliant wireless LAN may complywith any of one or more of the various IEEE 802.11 wireless LANstandards including, e.g., but not limited to, wireless LANs compliantwith IEEE std. 802.11a, b, d or g, such as, e.g., but not limited to,IEEE std. 802.11 a, b, d and g, (including, e.g., but not limited toIEEE 802.11g-2003, etc.), etc.

Unless specifically stated otherwise, as apparent from the followingdiscussions, it may be appreciated that throughout the specificationdiscussions utilizing terms such as “processing,” “computing,”“calculating,” “determining,” or the like, refer to the action and/orprocesses of a computer or computing system, or similar electroniccomputing device, that manipulate and/or transform data represented asphysical, such as electronic, quantities within the computing system'sregisters and/or memories into other data similarly represented asphysical quantities within the computing system's memories, registers orother such information storage, transmission or display devices.

In a similar manner, the term “processor” may refer to any device orportion of a device that processes electronic data from registers and/ormemory to transform that electronic data into other electronic data thatmay be stored in registers and/or memory. A “computing platform” maycomprise one or more processors.

According to an exemplary embodiment, exemplary methods set forth hereinmay be performed by an exemplary one or more computer processor(s)adapted to process program logic, which may be embodied on an exemplarycomputer accessible storage medium, which when such program logic isexecuted on the exemplary one or more processor(s) may perform suchexemplary steps as set forth in the exemplary methods.

Exemplary Operating Room Table Embodiment

FIG. 3 depicts an exemplary diagram of the table 107, according to anexemplary embodiment of the present invention. According to an exemplaryembodiment, the table 107 may include parts operable to move thepatient. In an exemplary embodiment, the table 107 may include, e.g.,but not limited to, a head piece 302, a torso piece 304, one or more armpieces 306A, 3068, and a leg piece 308. According to an exemplaryembodiment, the table 107 may use parts of the table to move body partsof a patient, such as, e.g., but not limited to, the patient's head, thepatient's arms, the patient's legs, etc., individually or incombination. In an exemplary embodiment, the table 107 may position apatient, such as, e.g., but not limited to, tilt, rotate, flex, reflex,incline, decline, etc. According to an exemplary embodiment, the table107 may include an interface 310 operable to receive instructions from auser to position the table 107. According to one exemplary embodiment,the interface 310 may be coupled to the table, as shown, via anexemplary cable. According to another exemplary embodiment, theinterface 310 may be coupled via, e.g. but not limited to acommunications link such as, e.g., but not limited to, a wirelesscommunications link, etc. In an exemplary embodiment, the table 107 mayreceive information and/or instructions for positioning from the tableintegration unit 105. According to an exemplary embodiment, the table107 may receive information from a user and/or a table integration unit105. According to an exemplary embodiment, components may be attached toand/or detached from the table 107 to facilitate particular types ofoperations. An exemplary table 107 may be an AMSCO 3085 SP SurgicalTable made by Steris Corporation of Mentor, Ohio, U.S.A.

Exemplary Electromechanical Control

According to an exemplary embodiment of the present invention, the table107 may move one or more portions of the table 107 using, e.g., but notlimited to, electromechanical movement. In an exemplary embodiment,electromechanical movement may include, e.g., but not limited to,hydraulic movement, pneumatic movement, magnetic movement, or mechanicalmovement. According to an exemplary embodiment, the table 107 mayinclude, e.g., but not limited to, pumps. In an exemplary embodiment,the exemplary pumps may manipulate fluid and/or gas pressure to moveparts of the table 107. According to an exemplary embodiment, the tablemay include, e.g., but not limited to, electrical motors. In anexemplary embodiment, the exemplary electrical motors may providemechanical force to move parts of the table 107.

According to an exemplary embodiment, the table 107 may include one ormore servo-mechanisms. In an exemplary embodiment, the servo-mechanismmay automatically ameliorate positioning effect. According to anexemplary embodiment, the servo-mechanism may include, e.g., but notlimited to, electro-mechanical parts of the table 107, where the partsof the table may be moved in response to feedback based on positioningeffect. In an exemplary embodiment, the servo-mechanism may be, e.g.,but not limited to, a servo-motor. According to an exemplary embodiment,one or more parts of the table 107 may be electromechanically positionedby the exemplary servo-motor to reduce positioning effect.

Exemplary Patient Module

In an exemplary embodiment, the PEDD 104 may be a small, lightweightPDA-sized device that may hang on, e.g., but not limited to, anoperating table 107. The PEDD 104 may have storage and/or print featuresto provide a graphical record of the results. The PEDD 104 may beconnected and/or coupled to a display 106 through, e.g., but not limitedto, a single cable. According to one exemplary embodiment, the display106 may include, one, two, or more screens. The first exemplary screenmay display an anatomical diagram that may first light up in, e.g., butnot limited to, yellow to warn of a significant change and then, e.g.,but not limited to, in red as an alarm of a critical change in thewaveforms. The first exemplary screen may be designed so interpretationof data may not require expertise in neuromonitoring. The secondexemplary screen may display the waveforms and the waveform's associatedamplitude and latency values.

In an exemplary embodiment, the PEDD 104 may be packaged as alightweight 5″×3″×1″ plastic, liquid proof case. The PEDD 104 may have4-stimulation channels and 6 channels for recording, according to anexemplary embodiment. The electrodes may connect and/or couple to thePEDD patient module (PEDD-PM) through, e.g., but not limited to, asingle D-shell connector that may be attached and/or coupled toexemplary, but non-limiting, disposable electrodes. In an exemplaryembodiment, each electrode may be color-coded and/or labeled, indicatingplacement sites (including, e.g., but not limited to, Stim—R Wrist,Record—L Cortical, etc.). The electrodes may be surface-sticky, in anexemplary embodiment. However the electrodes, such as, e.g., but notlimited to, two scalp electrodes, may instead be sub-dermal needles. Inone exemplary embodiment, the display 106 may be, e.g., but not limitedto, a small flat panel that may fit among other physiological monitoringdisplays. The exemplary flat panel display may plug into an electrical,such as, e.g., but not limited to, AC or DC, receptacle for power.

According to an exemplary embodiment, the PEDD 104 may be easy to use.An anesthesiologist and/or surgical nurse may be able to connect and/orcouple all of the electrodes 102 and 103 in, e.g., but not limited to,about two minutes or less. In an exemplary embodiment, the PEDD 104 mayautomatically test for electrode impedances and provide information onthe quality of the recording. According to an exemplary embodiment, thePEDD 104 may automatically adjust the stimulation level. In an exemplaryembodiment, the PEDD 104, if desired, may provide an alarm if thepotentials deviate significantly from baseline measurements. Accordingto an exemplary embodiment, the PEDD 104 may also provide an alert ifthe patient has, e.g., but not limited to, a peripheral neuropathy orother nerve disorder that may prevent the collection of reliablebaseline waveforms.

Embodiments of the present invention may include apparatuses forperforming the operations herein. An apparatus may be speciallyconstructed for the desired purposes, or it may comprise a generalpurpose device selectively activated or reconfigured by a program storedin the device. In yet another exemplary embodiment, the invention may beimplemented using a combination of any of, for example, but not limitedto, hardware, firmware and software, etc. References to “oneembodiment,” “an embodiment,” “example embodiment,” “variousembodiments,” etc., may indicate that the embodiment(s) of the inventionso described may include a particular feature, structure, orcharacteristic, but not every embodiment necessarily includes theparticular feature, structure, or characteristic. Further, repeated useof the phrase “in one embodiment,” or “in an exemplary embodiment,” donot necessarily refer to the same embodiment, although they may.

In the description and claims, the terms “coupled” and “connected,”along with their derivatives, may be used. It should be understood thatthese terms are not intended as synonyms for each other. Rather, inparticular embodiments, “connected” may be used to indicate that two ormore elements are, or may be, in direct physical or electrical contactwith each other. “Coupled” may mean that two or more elements are, ormay be, in direct physical or electrical contact. However, “coupled” mayalso mean that two or more elements are not in direct contact with eachother, but yet may still co-operate or interact with each other.

Finally, while various exemplary embodiments of the present inventionhave been described above, it should be understood that they have beenpresented by way of example only, and not limitation. Thus, the breadthand scope of the present invention should not be limited by any of theabove-described exemplary embodiments, but should instead be definedonly in accordance with the following claims and their equivalents.

What is claimed is:
 1. A method of identifying positioning effect in apatient, the method comprising: positioning a patient in a position formedical care or treatment; stimulating one or more peripheral nerves ofthe patient with one or more electrical pulses from at least onestimulating electrode; recording with a computer resultant electricalwaveforms generated by a nervous system of the patient in response tothe electrical pulses using at least one recording electrode; detectingchanges in the resultant electrical waveforms; and analyzing thedetected changes in the resultant electrical waveforms to automaticallyidentify the positioning effect, the positioning effect comprising animmediate or potential injury to the one or more peripheral nerves dueto stress associated with the position of the patient.
 2. The method ofclaim 1, wherein said at least one stimulating electrode is coupled toat least one of: an arm of the patient; a leg of the patient; an ulnarnerve of the patient; a median nerve of the patient; or a posteriortibial nerve of the patient.
 3. The method of claim 1, wherein said atleast one recording electrode is coupled to at least one of: a trunk ofthe patient; an Erb's point of the patient; a head of the patient; or aneck of the patient.
 4. The method of claim 1, wherein the resultantelectrical waveforms are somatosensory evoked potential waveforms. 5.The method of claim 1, wherein said identifying comprises at least oneof: comparing, by the at least one computing device, information basedon the resultant electrical waveforms to information from an anesthesiamachine to determine when changes in the resultant electrical waveformsare due to anesthesia; or comparing, by the at least one computingdevice, information based on the resultant electrical waveforms toinformation from a blood pressure machine to determine when changes inthe resultant electrical waveforms are due to blood pressure.
 6. Themethod of claim 1, further comprising: determining how to reduce thepositioning effect based on a position of a table.
 7. The method ofclaim 1, further comprising: providing information based on thepositioning effect to a table.
 8. The method of claim 1, furthercomprising: providing information to a table to at least partiallyreposition said table to reduce the positioning effect.
 9. The method ofclaim 1, further comprising: adjusting a position of the patient basedon the positioning effect using an electromechanism of a table.
 10. Themethod of claim 1, further comprising: alerting a user to thepositioning effect using at least one of: a notification; an alert; acommunication; an indication; or an alarm.
 11. The method of claim 1,further comprising: displaying information based on the resultantelectrical waveforms on at least one display.
 12. The method of claim 1,further comprising: receiving a user input regarding the accuracy of theresultant electrical waveforms.
 13. The method of claim 1, furthercomprising identifying a particular nerve structure affected by thepositioning effect.
 14. The method of claim 1, further comprisingrecommending changes in the position of the patient to ameliorate thepositioning effect.
 15. The method of claim 1, further comprisingcorrecting the positioning effect by providing for movement of a tableon which the patient is positioned.
 16. The method of claim 1, whereinthe medical care or treatment comprises cardiac surgery, spine surgery,or scoliosis surgery.
 17. A method of automatically identifyingpositioning effect in a patient placed in a position for medical care ortreatment, performed fully by an evoked potential detection computer,the method comprising: generating one or more electrical pulses fortransmission to at least one stimulating electrode to stimulate one ormore peripheral nerves of the patient, wherein the at least onestimulating electrode is attached to the patient over the one or moreperipheral nerves; recording resultant electrical waveforms generated bya nervous system of the patient in response to the electrical pulses,the resultant electrical waveforms received from at least one recordingelectrode attached to the patient over the spine, neck, or head;detecting a change in latency, amplitude, or morphology of the resultantelectrical waveforms; comparing the resultant electrical waveforms fromtwo or more limbs of the patient to determine if the detected change iscaused by a systemic effect; and analyzing the detected change in theresultant electrical waveforms to automatically identify the positioningeffect, the positioning effect comprising an immediate or potentialinjury to the one or more peripheral nerves of the patient due totension or compression on the one or more peripheral nerves caused bythe position of the patient.